Although international medical graduates provide invaluable services to the United States, these clinicians are also often a critical resource for their home countries. As such, US policy makers and medical educators must think critically about these shared benefits, according to an article published in JAMA.

Joseph Nwadiuko, MD, MPH, of the Department of Medicine at Johns Hopkins School of Medicine in Baltimore, Maryland, and colleagues note that in 2017, international medical graduates accounted for 13.2% of all awarded first-year US residency positions.

The authors point out that for decades there have dual concerns regarding the immigration of international medical graduates into the United States: first, meeting increasing US demands for physicians and second, concerns that migration could exacerbate staff shortages in the home countries of these physicians. This second concern has led to policies such as the WHO Global Code of Practice on the International Recruitment of Health Personnel passed by the World Health Organization in 2010, encouraging high-income countries to curb use of healthcare workers from countries with health worker shortages. However, to date there has been no substantial effect on immigration into the United States; an increase in the growth rate of sub-Saharan African-trained migrants was noted from 3.9% per year in 2002 to 2010, to 5.8% per year from 2010 to 2013.

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However, the authors argue that migration of physicians from low- and low-middle-income countries may not need to be tightly restricted to improve health care internationally. Many of these physicians return to their home countries — a 2014 survey found that 48% of 1064 surveyed physicians practicing in South Africa had experience practicing in a foreign country. International medical graduates also contribute to their country of origin in other ways. A 2011 study reported that 1759 African-born and African-educated physicians actively practicing in the United States and Canada donated an average of $6500 in remittances toward family members, friends, and organizations annually. Many donate toward healthcare in their home country as well.

Other international medical graduates donate their time. A study of 66 international surgeons reported that 56% had temporarily returned to their home country for professional reasons, with 78% of those teaching or engaging in clinical practice.  

Saudi Arabia sponsors a number of residency positions in Canada for its graduates, allowing them to pursue valuable training, while expecting — and facilitating — their ultimate return. Residency sponsorship programs could allow international medical graduates to pursue specialty training not available in their country of origin and prepare them for advanced practice while encouraging their eventual return.

The authors conclude that if the United States “limits [international medical graduate] entry or fails to assist in their return to country of origin, there is a risk of squandering a key aspect of US influence throughout the world.”


Nwadiuko J, Varadaraj V, Ranjit A. International medical graduates — a critical component of the global health workforce. JAMA. 2018;319(8):765-766.